Holcomb J B, Pusateri A E, Harris R A, Charles N C, Gomez R R, Cole J P, Beall L D, Bayer V, MacPhee M J, Hess J R
Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA.
J Trauma. 1999 Jan;46(1):49-57. doi: 10.1097/00005373-199901000-00009.
We conducted this study to determine whether the dry fibrin sealant dressing (DFSD) would stop bleeding from a grade V liver injury and to evaluate the effects of leaving the absorbable DFSD in survival animals.
Twenty-four swine (40+/-3.0 kg) received a uniform grade V liver injury and were randomized to one of four 1-hour treatment groups: (1) gauze packing, (2) DFSD, (3) immunoglobulin G placebo dressing, and (4) no treatment. All animals were resuscitated with lactated Ringer's solution. Total blood loss (TBL), mean arterial pressure, resuscitation volume, and laboratory data were monitored for 1 hour after injury. Four swine were treated with the DFSD after grade V injury and allowed to survive for 7 or 14 days.
The TBL was 1,104+/-264 mL (mean +/- SEM), 544+/-104 mL, 4,223+/-1,555 mL, and 6,026+/-1,020 mL for groups 1, 2, 3, and 4 respectively. TBL in DFSD animals was less than that in animals treated with gauze packing (p = 0.06). Grade V injuries were uniform among the 1-hour groups, and no evidence of intrahepatic abscess, unusual adhesions, or hepatic vein, vena caval, or pulmonary thromboses were noted in the long-term survival animals.
In this model of grade V liver injury, blood loss with the DFSD was 51% of that observed with standard gauze packing (not statistically different). Initial survival data revealed no complications attributable to the fibrin dressing. DFSD may provide simple, rapid, and definitive hemorrhage control in life-threatening liver injuries without the need for reoperation.
我们开展这项研究以确定干式纤维蛋白封闭剂敷料（DFSD）能否止住Ⅴ级肝损伤的出血，并评估在存活动物体内留置可吸收DFSD的效果。
24头猪（体重40±3.0千克）接受统一的Ⅴ级肝损伤，随机分为4个1小时治疗组之一：（1）纱布填塞，（2）DFSD，（3）免疫球蛋白G安慰剂敷料，（4）不治疗。所有动物均用乳酸林格氏液复苏。伤后1小时监测总失血量（TBL）、平均动脉压、复苏容积和实验室数据。4头猪在Ⅴ级损伤后用DFSD治疗，并存活7天或14天。
第1、2、3和4组的TBL分别为1104±264毫升（均值±标准误）、544±104毫升、4223±1555毫升和6026±1020毫升。DFSD组动物的TBL低于纱布填塞治疗的动物（p = 0.06）。1小时组的Ⅴ级损伤情况一致，长期存活动物未发现肝内脓肿、异常粘连或肝静脉、腔静脉或肺血栓形成的证据。
在这个Ⅴ级肝损伤模型中，DFSD导致的失血量是标准纱布填塞失血量的51%（无统计学差异）。初步生存数据显示，没有并发症可归因于纤维蛋白敷料。DFSD可能为危及生命的肝损伤提供简单、快速和确定性的出血控制，而无需再次手术。
